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PubMed1999

Culture, conceptive technology, and nursing.

Technology is a form of cultural expression, formed of and forming culture. A paradox about technological innovation is that, in addition to creating new human arrangements and possibilities, it often serves only to reinforce existing sociocultural practices, norms, and values. The technologically radical is often the culturally conservative. Conceptive technology has contributed toward the redefinition of patienthood, the multiplication of models of infertility, and the reinforcement of existing cultural norms. Nurses are well-positioned to conduct a kind of technology assessment that places culture and ethics at the center of inquiry. They are also well-positioned to assist women and their partners seeking technological assistance to reproduce to understand the controversies concerning conceptive technology that may account for their own ambivalence toward continuing or terminating medical treatment, societal ambivalence toward supporting expensive fertility treatments, and cultural ambivalence toward technological development.

Culture↗
PubMed2002

Socio-cultural implications of changing organizational technologies in the provision of care.

Technology refers to inputs (machines, bureaucratic procedures, management strategies) organized to achieve specified outcomes. Such inputs and how they are used arise from socio-cultural conditions and in turn influence social behavior and values. Advances in medical technology are due to the high value populations place on health, emerging developments in science (also a cultural product). and from the opportunities and incentives the society gives to varying stakeholders. In the United States for example, the development and uses of medical technology are shaped by faith in marketplace competition, technological progress, activism, choice and consumerism. This constellation of values has resulted in very rapid growth and dissemination of hardware and related procedures whose costs pose significant financial dilemmas. In response, a range of management technologies have been developed to restrain the excesses of intervention but, because they are counter to many prevailing values and interests, they have led to much tension and a social backlash. Resolving these rationing tensions--which are rarely acknowledged as such--is a major challenge in American medical care and in much of the world. In the context of American social values, once new preventive or treatment technologies are introduced, they take patients on treatment trajectories that are difficult to control and which result in many being labeled with diagnoses they do not have and receiving interventions they do not need. Major efforts are under way to increase the sophistication of consumers of health care in a manner consistent with evidence-based medicine but these face significant barriers. Underlying what at first appears as simply technical barriers are the particular social and cultural influences on how people acquire and use information, the sources they trust and distrust, and the types of information they find credible and relevant to their situations. In short, the competition between new preventive and treatment technologies and managed care technologies is at its heart a culture war.

Attitude to Health↗
PubMed1987

Decision making on the adoption of advanced medical technology in Taiwan.

This paper discusses both the current interest in and approaches to the employment of advanced medical technology in Taiwan. It describes the formation of the national policy, including funding, reimbursement, and regulatory processes, on adopting innovative and expensive medical technologies. Using the case of extracorporeal shockwave lithotripsy (ESWL), the key players who affect organizational decision making on the adoption and diffusion of medical technology have also been analyzed. Finally, it examines some of the salient features of medical technology adoption and assessment in Taiwan, and in other countries which depend heavily upon imported advanced medical technology. It is hoped that an understanding of Taiwan's attempts to use innovative medical technology wisely while incorporating the practice of technology assessment and appropriate policies, will assist other countries with similar conditions to gain maximal benefit from technological advancement.

Decision Making, Organizational↗
PubMed2000

Health technology assessment in Germany. Status, challenges, and development.

The objectives of this paper are to describe the status and development of health technology regulation with regard to coverage decisions and utilization, and to analyze the current situation of health technology assessment (HTA) in Germany. The relevant literature for controlling health technologies was identified by searching the literature and databases and through personal contacts. The literature was analyzed with regard to the different sectors in the healthcare system. For the analysis of the current state of HTA in Germany, a national survey was carried out. In addition, the names of topics under assessment were collected. The results show that coverage decisions in the ambulatory sector appear to be much more regulated than those in the inpatient sector. The same is true for diffusion and usage of technologies. The strict separation of the hospital and the ambulatory care sector in Germany constitutes a barrier to regulation and to making HTA an effective instrument in Germany. Until recently, HTA in Germany focused on biotechnology, such as gene technology. Recently the German Scientific Working Group of Technology Assessment in Health Care has adopted a systematic methodology to undertake HTAs. It can be concluded that regulation of health technologies in Germany is characterized by inconsistencies ranging from strict regulation in the ambulatory sector to almost no regulation in the rehabilitation sector. Increasing interest in HTA, in conjunction with a high priority assigned to evaluation of health technologies by the newly elected government, is likely to improve this situation in the future.

Ambulatory Care↗
PubMed2000

The use of technologies to minimize exposure to perioperative allogeneic blood transfusion in elective surgery. A survey of Canadian hospitals.

BACKGROUND: Despite the growing medical and public interest in reducing exposure to allogeneic blood, little is known about the use of alternatives to allogeneic transfusion. This study was conducted to determine the availability of these technologies in Canadian hospitals and was undertaken under the auspices of the International Study of Peri-Operative Transfusion (ISPOT), a 10-country study of the effectiveness of, attitudes toward, and practices related to the use of alternatives to allogeneic transfusion. METHODS: A cross-sectional national mail survey of Canadian hospitals with greater than 50 medical/surgical beds. Chiefs of anesthesia, surgery, and the divisions of cardiac, orthopedic, vascular, and urology were initially mailed a brief postcard asking which of seven technologies were used in their center. This was then followed up with a one-page questionnaire asking how frequently the technologies were used, their thoughts on the appropriateness of the use of the technologies, barriers to their greater use, and reasons for nonuse of the technologies. RESULTS: Response rates to the postcard survey ranged from 70%-98%, depending on the technology and type of surgery, and ranged from 27%-53% for the follow-up questionnaire. All technologies were used most frequently in cardiac surgery. Aprotinin, tranexamic acid, aminocaproic acid, desmopressin, and cell salvage were reported used in over 70% of cardiac surgery centers. Of these, tranexamic acid and cell salvage were the only ones used routinely in some centers. Acute normovolemic hemodilution and erythropoietin were used in 45% and 20% of cardiac centers, respectively. The drugs were used in less than 15% of orthopedic, vascular, and urologic divisions, with the exception of desmopressin in urologic and vascular surgery and aminocaproic acid in urologic surgery. The techniques of cell salvage and acute normovolemic hemodilution were used in 30%-45% of these divisions, with the exception of cell salvage, which was used in less than 15% of urology units. In more than 60% of cases, the technologies were considered to be used "about right," although an important minority felt that they were underused. CONCLUSIONS: In general, alternatives to perioperative allogeneic transfusion were rarely used except in cardiac surgery.

Blood Loss, Surgical↗
PubMed2003

Decision making in acquiring medical technologies in Israeli medical centers: a preliminary study.

OBJECTIVE: This preliminary study had two objectives: a) charting the considerations relevant to decisions about acquisition of new medical technology at the hospital level; and b) creating a basis for the development of a research tool that will examine the function of the Israeli health system in assessment of new medical technologies. METHODS: A comprehensive literature review and in-depth interviews with decision makers at different levels allowed formulation of criteria considered by decision makers when they decide to purchase and use (or disallow the use) of new medical technology. The resulting questionnaire was sent to medical center directors, along with a letter explaining the goals of the study. The questionnaire included 31 possible considerations for decision making concerning the acquisition of new medical technology by medical centers. The interviewees were asked to indicate the relevance of each consideration in the decision-making process. RESULTS: The most relevant criteria for the adoption of new technologies related to the need for a large capital investment, clinical efficacy of the technology as well as its influence on side effects and complication rates, and a formal approval by the Ministry of Health. Most interviewees stated that pressures exerted by the industry, by patients, or by senior physicians in the hospital are less relevant to decision making. Very small and usually not statistically significant differences in the ranking of hospital directors were found according to the hospitals' ownership, size, or location. CONCLUSIONS: The present study is a basis for a future study that will map and describe the function of hospital decision makers within the area of new technology assessment and the decision-making process in the adoption of new healthcare technologies.

Academic Medical Centers↗
PubMed2002

Transfer of space technologies past and present: the Russian case.

Since the end of the 1980's transfer of government sponsored high technology space goods and services to other sectors, industry, and eventually non-government use has been a growing concern of the Russian policy makers. Today the real and functional transformation of this field is on the agenda. The paper is organized as follows. The first section analyzes the evolution of the common approach to technology transfer, looks at the main obstacles to this processes as a whole, and in the space sector in particular. The second section examines the Russian space R&D sector from the point of view of its role and place in the Russian scientific and technological base. New mechanisms of technology transfer are then considered. Here, problems of conversion, commercialization, dual-use, and internationalization are examined in the context of space technology transfer. Furthermore, issues of innovation in technology transfer are discussed. The new networks that are forming through which technologies diffuse is considered. The paper then turns to legislative and regulatory problems, including the discussion of the main principles of the Russian space transfer code, which is now being drafted. It is necessary to underline, that in the Russian case, official statistics still do not help analyze the question of technology transfer.

Government Agencies↗
PubMed2003

New visual technologies in court: directions for research.

Litigation is being transformed by new visual communication technologies, including videoconferencing, PowerPoint, and computer animations. Yet the effects of these visual technologies on legal decision making are largely unknown. In order to understand better the most pressing issues surrounding technology in the courtroom, psychologists, lawyers, and representatives from technology companies and funding agencies attended a Research Conference on Courtroom Technology organized by the Federal Judicial Center. The goals of the conference were to identify issues raised by courtroom uses of new technologies that could be illuminated by empirical research and to suggest designs and methods for conducting that research. This paper emerged from that conference. The authors provide an overview of considerations that should guide research in this area, including a framework that takes into account features of the technology, the audience, and the legal strategy of the user of the technology. They outline a paradigm for conducting such research, illustrate it with several possible empirical studies of varying levels of experimental and conceptual complexity, and identify directions for subsequent research.

Audiovisual Aids↗
PubMed1992

Technology assessment in medicine.

The author defines the concepts medical technology and technology assessment and presents a paradigm for the evaluation of medical technologies. He proposes a hierarchical assessment scheme in which level I, biologic plausibility, compares the technology's proposed mode of action with current biologic information and theory. Level II, technical feasibility, determines whether the technology can be delivered to the target population. Level III, intermediate outcomes, assesses whether the technology has a short-term impact on the biologic or physiologic process that is diseased. Level IV, patient outcomes, investigates the overall medical, psychologic, and financial impacts of the technology upon the patient, including unintended side effects and long-term morbidity and mortality. Level V, societal outcomes, measures the cost of the technology to society in terms of resource use, ethical issues, and social and political hazards. As an example, the author employs this scheme to analyze the use of screening tests for hypercholesterolemia.

Biological Science Disciplines↗
PubMed1998

Technology utilization in the cardiac surgical patient: SvO2 and capnography monitoring.

Technology utilization in the cardiac surgical patient has proliferated, despite a lack of evidence that the technology has a positive impact on patient outcomes. Hospitals are left to their own efforts in deciding how and what technology to use. The result is an inconsistent use of technology. The use of structured guidelines can help hospitals improve the use of technology. Two controversial technologies, capnography and mixed venous oxygen saturation monitoring, are analyzed using this approach. It is essential for hospitals to support clinicians as they use methods in the evaluation and implementation of technology. Technology alone will not improve patient outcome or control costs.

Capnography↗
PubMed1981

Evaluating the costs and benefits of a diagnostic technology: the case of upper gastrointestinal endoscopy.

Medical technology assessment has been proposed as a way to encourage more appropriate use of medical technologies, which may in turn lower medical care costs. The application to a diagnostic technology of techniques for medical technology assessment is discussed, using upper gastrointestinal endoscopy as an example. Several generic problems are often encountered when performing an assessment of a diagnostic technology. These problems include the need to weigh relatively concrete data on clinical and economic costs against less quantifiable data on the value of the information gained from the procedure. In the case of upper gastrointestinal endoscopy, data on morbidity (approximately two cases per 1,000 cases), mortality (approximately one case per 20,000 cases), changes (approximately +290 per procedure), and costs (between +69 and +128 per procedure) are relatively easily determined. Less easily calculated is the marginal diagnostic gain from endoscopies performed for the wide variety of conditions for which an endoscopy may be indicated. It is concluded that, in the case of diagnostic technologies, technology evaluations may be most useful as a heuristic tool. Because of the difficulty in weighing costs and benefits, however, formal evaluations of diagnostic technologies are not likely in the near future to contribute to medical care cost containment.

California↗
PubMed2004

The postmodern heart: war veterans' experiences of invasive cardiac technology.

BACKGROUND: The consequences of war and medical discourse have historical connections to pacemaker technology. Understanding these consequences is important because war veterans, medicine and cardiac technology have a shared history that continues into the present. The incidence of Australian war veterans needing cardiac pacemakers has increased many-fold in recent years, due to advancing age. This need was recognized by the Australian Department of Veteran Affairs and a cardiac programme was established in the veteran hospital that was the setting for this study. AIM: This paper reports on a study aimed at capturing the interest and sensitizing the practice of nurses involved in the care of war veterans and other health care consumers who have been diagnosed as requiring a cardiac pacemaker. The study sought to answer the question, 'How does the war veteran experience his body in relation to invasive cardiac technology?'. METHOD: The research was guided by the principles of interpretive interactionism, and used unstructured interviews with eight male war veterans. The data were collected in 2000. FINDINGS: Thematic and content analysis revealed five themes: emotional knowing; the medical encounter; belief in the myth of miracle; technological constraint; and the altered heart. The findings indicated that the human dimension was characterized by experiences of ambivalence, inner conflict, powerlessness and suffering. CONCLUSION: Nursing is at the interface of science and patient care, and this study contributes to nursing knowledge by focusing on a previously unresearched topic, namely embodied interactions between war veterans and invasive cardiac pacemakers. Within a highly technical area such as cardiology, nurses can still work around the technology and keep patients as their primary focus, thus promoting quality care. A humanistic rather than a technological focus locates nurses between patients and cardiac technology. In this in-between location, nurses are not an extension of cardiac technology but a valuable source of information, education, and counselling.

Adaptation, Psychological↗
PubMed2005

Technology dependence and health-related quality of life: a model.

AIM: This paper presents a new theoretical model to explain people's diverse responses to therapeutic health technology by characterizing the relationship between technology dependence and health-related quality of life (HRQL). INTRODUCTION: Technology dependence has been defined as reliance on a variety of devices, drugs and procedures to alleviate or remedy acute or chronic health problems. Health professionals must ensure that these technologies result in positive outcomes for those who must rely on them, while minimizing the potential for unintended consequences. Little research exists to inform health professionals about how dependency on therapeutic technology may affect patient-reported outcomes such as HRQL. Organizing frameworks to focus such research are also limited. MODEL: Generated from the synthesis of three theoretical frameworks and empirical research, the model proposes that attitudes towards technology dependence affect HRQL through a person's illness representations or commonsense beliefs about their illness. Symptom distress, illness history, age and gender also influence the technology dependence and HRQL relationship. Five concepts form the major components of the model: a) attitudes towards technology dependence, b) illness representation, c) symptom distress, d) HRQL and e) illness history. CONCLUSION: The model is proposed as a guide for clinical nursing research into the impact of a wide variety of therapeutic health care interventions on HRQL. Empirical validation of the model is needed to test its generality.

Adolescent↗
PubMed2003

Beyond public perceptions of gene technology: community participation in public policy in Australia.

Public policy assumptions, which view "the public" as passive consumers, are deeply flawed. "The public" are, in fact, active citizens, who constitute the innovation end of the seamless web of relationships, running from research and development laboratory to shop, hospital or farm, or local neighborhood. "The public" do not receive the impact of technology; they are the impact, in that they determine with gene technology (GT) developers and sellers what happens to the technology in our society. In doing so, they, or more rightly we, exercise particular, contextual knowledges and actions. We suggest that it is the ignorance of this aspect of innovation in policy processes that produces the distrust and resentment that we found in our interviews with "publics" interested in gene technology. This is consistent with Beck's description of the deep structural states of risk and fear in modern advanced societies with respect to new technologies, such as gene technology. Only policy processes that recognize the particular, local and contextual knowledges of "the public", which co-construct innovation, can achieve deep, social structural consideration of gene technology. And only such a deep consideration can avoid the polarized attitudes and deep suspicions that we have seen arise in places such as Britain. Such consideration needs the type of processes that involve active consultation and inclusion of "the public" in government and commercial innovation, the so-called deliberative and inclusionary processes (DIPs), such as consensus conferences and citizen juries. We suggest some measures that could be tried in Australia, which would take us further down the path of participation toward technological citizenship.

Australia↗
PubMed2005

Frosta: a new technology for making fast-melting tablets.

The fast-melting tablet (FMT) technology, which is known to be one of the most innovated methods in oral drug delivery systems, is a rapidly growing area of drug delivery. The initial success of the FMT formulation led to the development of various technologies. These technologies, however, still have some limitations. Recently, a new technology called Frosta (Akina) was developed for making FMTs. The Frosta technology utilises the conventional wet granulation process and tablet press for cost-effective production of tablets. The Frosta tablets are mechanically strong with friability of < 1% and are stable in accelerated stability conditions when packaged into a bottle container. They are robust enough to be packaged in multi-tablet vials. Conventional rotary tablet presses can be used for the production of the tablets and no other special instruments are required. Thus, the cost of making FMTs is lower than that of other existing technologies. Depending on the size, Frosta tablets can melt in < 10 s after placing them in the oral cavity for easy swallowing. The Frosta technology is ideal for wide application of FMTs technology to various drug and nutritional formulations.

Administration, Oral↗
PubMed2000

The use of information technology in improving medical performance. Part II. Physician-support tools.

Increasing data from a few sites demonstrate that information technologies can improve physician decision making and clinical effectiveness. For example, computer-based physician order entry systems, automated laboratory alert systems, and artificial neural networks have demonstrated significant reductions in medical errors. In addition, Internet services to disseminate new knowledge and safety alerts to physicians more rationally and effectively are rapidly developing, and telemedicine to improve rural access to specialty services is undergoing substantial growth. However, even technologies demonstrated to yield beneficial effects have not yet achieved widespread adoption, though the pace of change appears to be increasing as the Internet takes hold. Scientific evaluation of many technologies is also lacking, and the dangers of some of these technologies may be underappreciated. Research on the effects of specific technologies should be a priority. Policies should be developed to press information technology companies, such as pharmaceutical and medical device manufacturers, to recognize the importance of clinical evaluation. Research could also analyze the characteristics of effective technologies and of physicians and organizations who implement these technologies effectively.

Biomedical Technology↗
PubMedDate not supplied

The two-edged sword: how technology shapes medical practice.

Technology is assuming an increasingly important role in medical practice and health care delivery, fueled by forces such as uncertainty, variability, error, and quality problems. While the benefits of technology are obvious, there are insidious costs that are harder to discern. Technology has a significant, but less appreciated, role in imposing standards and constraints upon medicine. These ancillary effects account for some of the physician reluctance to embrace technological innovations perceived as controlling. This article explores technology's wide-ranging effects in shaping medical care delivery. Technology is not a passive servant of the health care delivery system, but rather acts as a catalyst and shaper of that system. In the process of becoming more technological, medicine has been transformed from a profession with unmatched sovereignty into an industry shaped by technology amidst a context of social and political forces.

Attitude of Health Personnel↗
PubMed1995

Decision analysis as a life support technology assessment capability.

Applied research and technology development is often characterized by uncertainty, risk, and significant delays before tangible returns are obtained. Decision making regarding which technologies to advance and what resources to devote to them is a challenging but essential task, especially in a resource-constrained environment. In the application of life support technology to future manned space flight, new technology concepts typically are characterized by rough approximations of technology performance, uncertain future flight program needs, and a complex, time-intensive process to develop technology to a flight-ready status. Decision analysis is a quantitative, logic-based discipline that imposes formalism and structure to complex problems confronting a decision maker. It also accounts for the limits of knowledge available at the time a decision is needed. The utility of decision analysis to life support technology R&D was evaluated by applying it to two case studies. The methodology was found to provide useful insight for making technology development resource allocation decisions.

Costs and Cost Analysis↗